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Nakajima-Ohyama KC, Shizusawa Y, Uchiyama S, Kishi Y, Tanimukai H. Usefulness of Gabapentin as an Alternative/Adjunct Therapy for Delirium: A Retrospective Observational Study. J NIPPON MED SCH 2024; 91:233-240. [PMID: 38777784 DOI: 10.1272/jnms.jnms.2024_91-214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
BACKGROUND Antipsychotics are commonly used to treat delirium but can adversely affect the extrapyramidal and cardiac conduction systems. Antipsychotic use has also been reported to be associated with increased mortality in older adults. Therefore, alternative and adjunct medications for delirium are necessary. We retrospectively assessed the efficacy and safety of gabapentin (GBP) as an alternative and adjunct medication for delirium. METHODS We retrospectively investigated the records of patients with delirium treated with GBP (71 patients; median age, 81 years; interquartile range, 76-87.5 years; 54.9% males) at a general hospital. We examined duration to delirium improvement, as assessed by the Intensive Care Delirium Screening Checklist (ICDSC) and DSM-5 criteria, as well as adverse events. RESULTS The median (interquartile range) GBP dose was 200 mg (150-350 mg) /day. A total of 71.8% and 85.9% of the patients failed to meet the diagnostic criteria for delirium at 2 days and 5 days after initial administration, respectively (p<0.05). In subgroup analysis, patients with a history of epilepsy or cerebrovascular disease responded better to GBP than did those without such histories, suggesting that patients with abnormal/borderline neuronal activity respond to GBP even though they do not exhibit seizures. GBP did not induce extrapyramidal symptoms, cardiac conduction disturbances, hyperglycemia, or epilepsy but caused sleepiness and myoclonus. CONCLUSIONS GBP may improve delirium with fewer adverse effects and may be a safe alternative or adjunct treatment for delirium. Dosage adjustment may be necessary to prevent sleepiness.
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Affiliation(s)
- Kakusho Chigusa Nakajima-Ohyama
- Department of Neuropsychiatry, Nippon Medical School Musashi Kosugi Hospital
- Department of Neuropsychiatry, Ikeda Municipal Hospital
| | - Yoshie Shizusawa
- Department of Palliative Medicine, Ikeda Municipal Hospital
- Department of Palliative Medicine, Osaka Gyoumeikan Hospital
| | - Shotaro Uchiyama
- Department of Neuropsychiatry, Nippon Medical School Musashi Kosugi Hospital
| | - Yasuhiro Kishi
- Department of Neuropsychiatry, Nippon Medical School Musashi Kosugi Hospital
| | - Hitoshi Tanimukai
- School of Human Health Sciences, Graduate School of Medicine, Kyoto University
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2
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Strayer RJ, Friedman BW, Haroz R, Ketcham E, Klein L, LaPietra AM, Motov S, Repanshek Z, Taylor S, Weiner SG, Nelson LS. Emergency Department Management of Patients With Alcohol Intoxication, Alcohol Withdrawal, and Alcohol Use Disorder: A White Paper Prepared for the American Academy of Emergency Medicine. J Emerg Med 2023; 64:517-540. [PMID: 36997435 DOI: 10.1016/j.jemermed.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Reuben J Strayer
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York.
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Rachel Haroz
- Cooper Medical School of Rowan University, Cooper University Healthcare, Camden, New Jersey
| | - Eric Ketcham
- Department of Emergency Medicine, Department of Behavioral Health, Addiction Medicine, Presbyterian Healthcare System, Santa Fe & Española, New Mexico
| | - Lauren Klein
- Department of Emergency Medicine, Good Samaritan Hospital, West Islip, New York
| | - Alexis M LaPietra
- Department of Emergency Medicine, Saint Joseph's Regional Medical Center, Paterson, New Jersey
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, New York
| | - Zachary Repanshek
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Scott Taylor
- Department of Emergency Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Scott G Weiner
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lewis S Nelson
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
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3
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Gabapentin to treat acute alcohol withdrawal in hospitalized patients: A systematic review and meta-analysis. Drug Alcohol Depend 2022; 241:109671. [PMID: 36402053 DOI: 10.1016/j.drugalcdep.2022.109671] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Gabapentin is an antiepileptic medication with evidence of benefit in alcohol use disorder patients. The mechanism of action of gabapentin may also benefit patients suffering from acute alcohol withdrawal syndrome (AWS). METHODS A systematic review and meta-analysis were conducted to examine if gabapentin can effectively replace/reduce the use of benzodiazepines for the treatment of acute alcohol withdrawal symptoms in hospitalized patients. Time to alcohol withdrawal symptom resolution, amount of benzodiazepines administered, rate of resolution of alcohol withdrawal symptoms, serious withdrawal-related complications, and hospital length of stay (LOS) were examined. RESULTS Eight retrospective studies (n = 2030) were included in this meta-analysis. There were no studies that examined study outcomes for patients who received only gabapentin and no benzodiazepines; in all studies, gabapentin-treated patients may have received benzodiazepines prior to gabapentin. There were no significant differences between gabapentin-treated and benzodiazepine-treated groups in time to symptom resolution, amount benzodiazepines administered, withdrawal-related complications, or LOS. There was a significant difference in the rate of symptom resolution favoring gabapentin-treated patients (p = 0.05); however, this analysis included only one study. Subgroup analyses of severe AWS patients revealed a significant decrease in LOS (p = 0.04) and a decrease in amount of benzodiazepines administered (p = 0.02) in gabapentin-treated patients, but these analyses included only one study. Subgroup analysis of patients receiving only gabapentin without benzodiazepines found a significantly decreased LOS in the gabapentin group compared to the benzodiazepine group (p < 0.001), but this analysis included only two studies. CONCLUSIONS There is insufficient evidence to support the widespread use of gabapentin to treat inpatients suffering AWS. All studies included in this meta-analysis are retrospective with high risk of confounding. Well-designed, randomized, controlled studies of gabapentin to treat patients with AWS are required.
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4
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Mocanu V, Cowan N, Klimas J, Ahamad K, Wood E. Modernizing Withdrawal Management Services. CANADIAN JOURNAL OF ADDICTION 2021. [DOI: 10.1097/cxa.0000000000000113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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5
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Cheng YC, Huang YC, Huang WL. Gabapentinoids for treatment of alcohol use disorder: A systematic review and meta-analysis. Hum Psychopharmacol 2020; 35:1-11. [PMID: 32667088 DOI: 10.1002/hup.2751] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/18/2020] [Accepted: 06/08/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Gabapentin (GBP) and pregabalin (PGB) have been used to treat alcohol use disorder (AUD) and alcohol withdrawal, but with inconsistent results. In this meta-analysis, we explored the effects of GBP/PGB treatment on AUD and their effects on withdrawal, craving, depression, and sleep disturbance in AUD patients. METHODS We carried out a systematic review and meta-analysis of randomized controlled trials comparing the effects of GBP/PGB on AUD with those of a placebo or control treatment. Electronic databases were searched for relevant articles published before September 2019. The primary outcome was defined as the efficacy measure on achieving abstinence or reducing alcohol consumption in a hierarchical order. We included 16 studies in our meta-analysis. RESULTS Overall, GBP had no significant benefit comparing to placebo or control treatment (Hedges' g = 0.0725, p = 0.6743). For specific alcohol-related outcome, GBP had significant effect on percentage of heavy drink (Hedges' g = 0.5478, p = 0.0441) and alcohol withdrawal symptoms (Hedges' g = 0.2475, p = 0.0425). GBP/PGB did not have significant beneficial effect on craving, depressive symptoms, or sleep disturbance. Instability was shown in sensitivity analyses of some above results. CONCLUSIONS GBP may be helpful to reduce AUD patients' heavy drinking behavior and withdrawal, but more studies are needed for drawing conclusions.
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Affiliation(s)
- Ying-Chih Cheng
- Department of Psychiatry, Taoyuan Psychiatric Centre, Ministry of Health and Welfare, Taoyuan City, Taiwan, ROC.,Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan, ROC.,Research Centre of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC
| | - Yu-Chen Huang
- Research Centre of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, ROC.,Department of Dermatology, School of Medicine and College of Medicine, Taipei Medical University, Taipei, Taiwan, ROC
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan, ROC.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan, ROC.,Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC
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6
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Bates RE, Leung JG, Morgan RJ, Fischer KM, Philbrick KL, Kung S. Retrospective Analysis of Gabapentin for Alcohol Withdrawal in the Hospital Setting: The Mayo Clinic Experience. Mayo Clin Proc Innov Qual Outcomes 2020; 4:542-549. [PMID: 33083703 PMCID: PMC7560568 DOI: 10.1016/j.mayocpiqo.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate the efficacy and safety of a fixed-dose gabapentin taper protocol for alcohol withdrawal in hospitalized patients. Patients and Methods We retrospectively identified patients admitted to the hospital from January 1, 2016, to April 30, 2018, for alcohol withdrawal syndrome. Based on the treatment that patients received, they were divided into the gabapentin, benzodiazepine, and combination treatment groups. The primary outcome was length of stay, defined as time from admission to either discharge or 36 hours with Clinical Institute Withdrawal Assessment (CIWA) score less than 10. Inverse probability of treatment weight was used to account for differences in baseline characteristics between groups. Results A total of 443 patients met criteria for inclusion (128, 253, and 62 patients in the gabapentin, benzodiazepine, and combination groups, respectively). Baseline characteristics were similar among all groups. The median gabapentin group length of stay was 4.0 hours shorter than the benzodiazepine group (P=.012). Maximum CIWA score was 2.2 points lower in the gabapentin group (P=.003). No statistical differences were noted among safety outcomes, including incidence of seizure, intensive care unit transfer, or delirium tremens. Results were not statistically altered by inverse probability of treatment weight analysis. Conclusion A fixed-dose gabapentin taper protocol appears to be an effective and safe alternative to CIWA-driven benzodiazepines in patients hospitalized with alcohol withdrawal syndrome, though further research is necessary to define the potential subpopulations that benefit most.
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Key Words
- AUD, alcohol use disorder
- AWS, alcohol withdrawal syndrome
- CIWA, Clinical Institute Withdrawal Assessment
- GABA, γ-aminobutyric acid
- ICU, intensive care unit
- IPTW, inverse probability of treatment weight
- LOS, length of stay
- Q, quartile
- max, maximum
- min, minimum
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Affiliation(s)
- Ruth E Bates
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, MN
| | | | - Robert J Morgan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Karen M Fischer
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Simon Kung
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
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7
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Alcohol Withdrawal Syndrome in Neurocritical Care Unit: Assessment and Treatment Challenges. Neurocrit Care 2020; 34:593-607. [PMID: 32794143 DOI: 10.1007/s12028-020-01061-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 07/21/2020] [Indexed: 12/11/2022]
Abstract
Alcohol withdrawal syndrome (AWS) can range from mild jittery movements, nausea, sweating to more severe symptoms such as seizure and death. Severe AWS can worsen cognitive function, increase hospital length of stay, and in-hospital mortality and morbidity. Due to a lack of reliable history of present illness in many patients with neurological injury as well as similarities in clinical presentation of AWS and some commonly encountered neurological syndromes, the true incidence of AWS in neurocritical care patients remains unknown. This review discusses challenges in the assessment and treatment of AWS in patients with neurological injury, including the utility of different scoring systems such as the Clinical Institute Withdrawal Assessment and the Minnesota Detoxification Scale as well as the reliability of admission alcohol levels in predicting AWS. Treatment strategies such as symptom-based versus fixed dose benzodiazepine therapy and alternative agents such as baclofen, carbamazepine, dexmedetomidine, gabapentin, phenobarbital, ketamine, propofol, and valproic acid are also discussed. Finally, a treatment algorithm considering the neurocritical care patient is proposed to help guide therapy in this setting.
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8
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Chernyavsky S, Dharapak P, Hui J, Laskova V, Merrill E, Pillay K, Siau E, Rizk D. Alcohol and the Hospitalized Patient. Med Clin North Am 2020; 104:681-694. [PMID: 32505260 DOI: 10.1016/j.mcna.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Alcohol use is a common social and recreational activity in our society. Misuse of alcohol can lead to significant medical comorbidities that can affect essentially every organ system and lead to high health care costs and utilization. Heavy alcohol use across the spectrum from binge drinking and intoxication to chronic alcohol use disorder can lead to high morbidity and mortality both in the long and short term. Recognizing and treating common neurologic, gastrointestinal, and hematological manifestations of excess alcohol intake are essential for those who care for hospitalized patients. Withdrawal is among the most common and dangerous sequela associated with alcohol use disorder.
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Affiliation(s)
- Svetlana Chernyavsky
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Patricia Dharapak
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Jennifer Hui
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Violetta Laskova
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Eve Merrill
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Kamana Pillay
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Evan Siau
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA
| | - Dahlia Rizk
- Department of Medicine, Mt Sinai Beth Israel, Icahn School of Medicine, 16th Street and 1st Avenue, New York, NY 10010, USA.
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9
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Wolf C, Curry A, Nacht J, Simpson SA. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open Access Emerg Med 2020; 12:53-65. [PMID: 32256131 PMCID: PMC7093658 DOI: 10.2147/oaem.s235288] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.
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Affiliation(s)
- Chelsea Wolf
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashley Curry
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Nacht
- Denver Health Medical Center, Denver, CO, USA
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Scott A Simpson
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Revol B, Jullian-Desayes I, Cracowski JL, Tamisier R, Mallaret M, Joyeux-Faure M, Pepin JL. Gabapentinoids and sleep apnea syndrome: a safety signal from the WHO pharmacovigilance database. Sleep 2019; 42:5261977. [PMID: 30590830 DOI: 10.1093/sleep/zsy242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/03/2018] [Indexed: 11/14/2022] Open
Affiliation(s)
- Bruno Revol
- HP2 Laboratory, Inserm, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Thorax and vessels, Grenoble Alpes University Hospital, Grenoble, France.,Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Ingrid Jullian-Desayes
- HP2 Laboratory, Inserm, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Thorax and vessels, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Cracowski
- HP2 Laboratory, Inserm, University Grenoble Alpes, Grenoble, France.,Clinical Pharmacology Department, Grenoble Alpes University Hospital, INSERM, Grenoble, France
| | - Renaud Tamisier
- HP2 Laboratory, Inserm, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Thorax and vessels, Grenoble Alpes University Hospital, Grenoble, France
| | - Michel Mallaret
- Pharmacovigilance Department, Grenoble Alpes University Hospital, Grenoble, France
| | - Marie Joyeux-Faure
- HP2 Laboratory, Inserm, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Thorax and vessels, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Louis Pepin
- HP2 Laboratory, Inserm, University Grenoble Alpes, Grenoble, France.,EFCR Laboratory, Thorax and vessels, Grenoble Alpes University Hospital, Grenoble, France
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